Background
Recent studies indicate that mechanical circulatory support (MCS) like veno-arterial extracorporeal membrane oxygenation (VA-ECMO) as well as Impella and particularly the combination of these two devices may play a significant role in the management of cardiogenic shock (CS) complicated from an acute coronary syndrome (ACS). However, there is a lack of large randomized trials exploring the efficacy of their combined use in treating ACS-associated CS. Therefore, systematic-reviews and meta-analyses are essential to better understand the potential benefits and risks of the combined use of these MCS types in this context.
Methods
This meta-analysis focused on studies examining exclusively the combined use of VA-ECMO with Impella for treating CS related to ACS. The main outcome measure was the mortality rate within 30 days, while major bleeding events and ischemic vascular complications were evaluated as secondary outcomes.
Results
A total of 17 observational retrospective studies (6,234 patients with CS with combination of VA-ECMO and Impella support) were included in this meta-analysis (Figure 1). Mean age of the total participants was 66.1 ± 12.12 years. A pooled mortality incidence of 53% (Random effects model of 0.54 with 95% Confidence Intervals (C.I.) 50 to 57, Figure 2) was found between all included participants, whereas the pooled ischemia rate was 12.2% (Random effects model of 0.18 with 95% C.I.: 11 to 25, Figure 3) and the pooled bleeding incidence was 30.8% (Random effects model of 0.2 with 95% C.I.: 10 to 31, Figure 4).
Conclusion
The 30-day mortality rate for patients suffering from acute coronary syndrome complicated by cardiogenic shock treated with both ECMO and Impella remains elevated. The significant incidence of complications emphasizes the necessity for utilizing this combination of devices exclusively in a carefully selected group of patients.
